Medicaid could be changing for some

Dylan LightfootStaff

April 10, 2013

With Gov. Pat McCrory’s announcement last Wednesday of his plan to overhaul N.C.’s Medicaid program by contracting managed care companies to care for the poor, disabled and elderly, Ashe County’s Medicaid patients and their health care providers may wonder what the future holds.

Today, 4,788 Ashe County residents — roughly one in six —- receive Medicaid benefits, according to the Department of Social Services.

These patients’ care is currently managed by AccessCare, a non-profit primary care coordination program. According to their Website, “AccessCare was founded in 1998…tasked with enhancing the existing Carolina ACCESS Medicaid program by developing physician-led community partnerships with disease management programs and employment of locally-based case managers.”

AccessCare is one of nine physician networks of Community Care of N.C. (CCNC), a nonprofit corporation that coordinates care for the 1.5 million North Carolinians covered by Medicaid and select commercial plans.

Hailed as a national model, CCNC received the Healthcare Leadership Council’s Wellness Frontiers Award, given to companies that successfully implement evidence-based wellness program that prevents disease and improve the well-being of a population.

The award was given the same day McCrory announced his Medicaid overhaul plan, which seeks to rein in and predict the N.C.’s $13 billion combined state and federal Medicaid budget. North Carolina’s Medicaid administrative costs are 30 percent above the national average, McCrory said

“There’s no reason you can’t manage patient care to manage costs, but you have to be willing to engage the patients,” said Ashe Memorial Hospital CEO R. D. Williams.

AccessCare has made great strides in patient wellness and management of care, overcoming barriers like transportation, language and child care issues, Williams said. The non-profit currently “manages care for 70-80 percent of insured patients Ashe, Alleghany and Watauga counties, including all Medicaid, Medicare, Blue Cross Blue Shield and state employees” he said.

And, while the managed care model has generally been good for state budgets where it has been implemented, it hasn’t necessarily been good for providers, Williams said.

“Providers already have difficulty getting paid (under N.C.’s current system),” he said. “I haven’t heard of a managed care system where reimbursement goes up.”

Virginia-based Amerigroup is one private, for-profit managed care firm eager to help N.C. reduce costs while improving care. A publicly-traded Fortune 500 company, their business model is focused on Medicaid administration.

“I would say we have had great results in improving quality in coordinated care at reduced cost to taxpayers,” said Amerigroup Vice President for Public Affairs and Communications Maureen McDonnell. The company takes a hands-on, holistic approach to physical and behavioural health, and takes very seriously its responsibility to its members, “who are some of the most vulnerable in society,” she said.

And the company’s model embraces solid working relationships with providers. “Working with providers and advocates in every community is critical,” she said.

Amerigroup is a wholly-owned subsidiary of insurance giant WellPoint, who paid over $4.9 billion in cash for the company last year. Asked who would win out when shareholder bottom lines conflicted with member care and provider relations, McDonnell was quick to point out Amerigrioup’s modest two to three percent profit margin, smaller than most government contractors.

McConnell said that the buyout also made the company a more effective care provider as they now had access to greater funding for research.

McCrory’s plan is not an across-the-board privatization of Medicaid, and AccessCare and the other CCNC care coordinators are well positioned to bid for contracts in an open market according to Williams.